Comparison Of Uterus Preservation Versus Hysterectomy In Transvaginal Modified Pelvic Floor Reconstruction

Background and Purpose:To maintain normal position of the females' genital,the anatomy and function properly of multi-muscle,fascia and ligaments of uterine is very important.Some reason that will weaken the support function of the floor,the degragation of pelvic floor tissue,poor trauma,congenital dysplasia of the pelvic floor,or some damage casused by the diseases,may lead to the female genital and the adjacent organs to move down.These known as pelvic organ prolapse(POP),including the descensus vaginal anterior,descensus vaginal posterior and uterine prolapse.Due to the rapidly aging populations of developed countries,pelvic organ prolapse(POP)has become a major healthcare and pelvic floor dysfunction is a common disease in older women.There are about almost 50%women who will have POP.Surgery for POP is frequent,with a lifetime risk of 10–20 % issue,which influences the physical and psychological health of women seriously.In 2004,the mesh was first used to treat vaginal prolapse,and the nine French scientists study the mesh so that concluded the Prolift mesh pelvic floor repair system,including full pelvic floor repair,anterior and posterior repair.The mesh as a mechanical support or materials of repairing defect used to treat and strengthen pelvic floor tissue structure.In 2008 and 2011,the Food and Drug Administration announced that serious complications associated with the surgical mesh used for POP repairs were not rare.The gynecologist become more caution when the mesh was used to the surgical of cure the POP.But for the anterior defect,the mesh is benefits,but there is still considerable controversy while reconstructive pelvic surgery must need a hysterectomy.It is five yesrs that our department use the mesh to treat POP in transvaginal modified pelvic floor reconstruction.and achieved satisfactory results and low complication rate.Thus,we retrospectively analyzed the clinical efficacy of vaginal mesh in pelvic floor reconstruction,comparative analysis and retain the uterus hysterectomy surgical results and quality of life.Thereby investigate the effects of long-term efficacy of surgical uterine surgery reserved.MethodsPatients who had undergone POP repair with Transvaginal modified pelvic floor reconstruction from 2009 to 2013 were identified by chart review in Southwest Hospital of Third Military Medical University.Of the 121 patients,concomitant hysterectomy was performed in 71 and uterus-sparing surgery in 53.Evaluate the pre-operativeand post-operative using objective pelvic organ prolapse quantification(POP-Q);comparison the perioperative parameters such as operating time and so on;The therapeutic effect and impact on quality-of-life were analyzed through scores of pelvic floor impact questionnaire-short form 7(PFIQ-7),pelvic floor distress inventory short form 20(PFID-20)and pelvic organ prolapsed-urinary incontinence sexual questionnaire(PISQ).Statistical comparisons incidence of postoperative complications and mesh erosion rate in the two groups of patients.Results(1)Compared with the concomitant hysterectomy,the uterus-sparing has shorter operative time,less mean blood loss,and less the cost of surgery,differences were statistically significant(p<0,05).Mean operating time of uterus-sparing group(54.49±24.62)was obviously less than concomitant hysterectomy group(103.70±34.43);mean blood loss in the operation was significantly less in uterus-sparing group(47.92±34.10)than in concomitant hysterectomy group(128.03±91.47);the mean cost of surgery was obviously less in uterus-sparing group(1905±396)vs(2566±530)in concomitant hysterectomy group.But the postoperative catheterization time,postoperative hospital stay and total hospitalization cost is not difference between two groups.(2)The objective cure rate was approximately 77.36% in uterus-sparing group and 81.69% in concomitant hysterectomy group,differences were not statistically significant(p>0,05).All of the POP-Q parameters(Aa,Ba,C,Ap,Bp,genital hiatus,perineal body,and total vaginallength)and stages were significantly improved(p<0.001)in both groups after surgery.Postoperative POP-Q values and stages did not differ significantly between the groups(p>0.05).(3)Subjective improvement was also assessed via the Pelvic Floor Impact Questionnaire-short form 7(PFIQ-7)and Pelvic Floor Distress Inventory short form 20(PFDI-20).There was significant ameliorationof symptoms in both groups after surgery(p<0.01),and there were no significant differences betweenthe concomitant hysterectomy group and the uterus-sparing group(p>0.05).(4)9 patients in uterus-sparing group and 8 patients in concomitant hysterectomy group had the sexual life,there was no statistical difference in mean scores of PISQ-12 between the two group postoperatively.(5)1 patient in uterus-sparing group and 3 patients in concomitant hysterectomy group happened mesh exposure,but there is no infection of the urinary after the operation.ConclusionThe surgery for pelvic organ prolapsed have objective and subjective improvement in both group,but the operative time,blood loss,and cost of surgery in uterus-sparing group have a significant improvement,so uterus conservation in modified pelvic floor reconstruction has become a valid option.